Group B Strep and Screening
What is GBS disease and how common is it?
The GBS bacterium is the most common cause of sepsis (blood infection) and meningitis (infection of the fluid and lining surrounding the brain) in newborns. GBS infection causes newborn pneumonia and is more common than other, better known, newborn problems such as rubella, congenital syphilis, and spina bifida. Of those mothers who do not receive antibiotics during labor, half of a percent (.5%) of these babies will develop a GBS infection ranging from very mild to severe. Approximately 8000 babies in the US get GBS disease each year and about 300 of these babies die (3.75% of those babies who actually get sick). The statistical chances of a baby having a fatal infection are approximately ONE out of 13,333 births. This is slightly greater than the rate for maternal mortality (the statistical chances of a woman dying) associated with vaginal birth, which is one out of 16,666. Babies that survive a serious GBS infection, particularly those who have meningitis, may have long-term problems, such as hearing or vision loss, or learning disabilities. In pregnant women, GBS can cause urinary tract infections, uterine infections (amnionitis), endometritis, and stillbirth.
Does everyone who has Group B Strep get sick with GBS?
No. Many people carry GBS in/on their bodies but do not become ill. These people are said to be "colonized". Adults can be colonized in the bowel, genital tract, urinary tract, throat, or respiratory tract. Fifteen to forty percent of pregnant women are colonized with GBS in the rectum or vagina. Because GBS does not usually cause problems for the adult female, many women carry it without knowing it. This bacteria can often "come and go". It is possible for an adult to carry GBS bacteria one day and then to not carry it the next day, or vice versa. It is not understood where one "gets" this bacteria and why it "comes and goes".
GBS can cause serious illness to a baby born to a woman who carries a bacteria. A fetus may become colonized with GBS if the mother is colonized with GBS in the rectum or vagina at birth. Colonization of the newborn does not mean that the baby will develop a dangerous infection. Many babies suffer no ill consequences from this bacteria. In other words......Just because the mother is a carrier of this bacteria does not mean that her baby will become colonized. Should the baby become colonized, it does not mean that the baby will get sick.
Those babies that do become colonized at birth and develop an infection will go from happy/healthy to dangerously ill very quickly--usually within the first few days ("early-onset GBS disease"). There have also been some studies of "late-onset GBS disease"--after one week postpartum--that have suggested a possible link to the babies contracting GBS after birth, possibly from hospital surroundings.
What babies are at highest risk for becoming colonized with GBS?
Risk factors which increase the chances of having a baby colonized with GBS include:
· Mother having membranes ruptured (spontaneously or artificially) for >24 hours before delivery
· Mother running a fever during labor
· Baby being premature
How does GBS Disease affect
newborns?
Approximately 1-2% of babies who are colonized with GBS develop signs and symptoms of GBS disease/infection. Three-fourths of the cases of GBS diseases disease among newborns are "early onset" forms of the disease, and most of these cases are apparent within a few hours after birth. Sepsis, pneumonia, and meningitis are the most common problems. Meningitis appears to be more common with "late-onset GBS disease". Premature babies are more susceptible to developing infections from GBS, though most colonized babies who develop problems are full term.
How do babies get sick from GBS Disease?
Most babies are exposed to GBS during labor and delivery. If a mother's membranes have ruptured, her baby may come into contact with GBS if the bacteria from the vagina travel upward to the uterus. A baby may also be exposed by passing through the vagina during birth. GBS exposure could be possible causes of preterm births, stillbirths, or miscarriage, but is definitely only one possible cause to these things.
Can I prevent myself from being colonized with the GBS bacteria?
Possibly. Some studies show that taking a probiotic supplement daily during pregnancy containing live acidophilus cultures can help. Probiotics restore the good bacteria in your body which "fight" the bad bacteria. The more healthy bacteria there is in your body the less likely the harmful bacteria will be able to multiply and "take over" (colonize). Probiotic supplements are only effective if they are refrigerated. The refrigerated varieties may be purchased at most health food stores.
There has also been some studies with herbal remedies such as echinachea, tea tree oil, etc. which may be succesful in the treatment or preventing of the GBS colonization in pregnant women. Please be sure to research and check with your provider before taking any medications or alternatives.
Can pregnant women be checked (or screened) for GBS?
Yes. GBS colonization can be detected during pregnancy by a vaginal and rectal swab. The CDC (Center for Disease control) recommends that you be screened for GBS at 35-37 weeks. A positive culture result means that you are colonized with GBS at the time of the screening--not that you or your baby will become ill. GBS can come and go from your body (so if your test results were negative, you might in fact be positive at your time of delivery and vice versa--if you test positive, you might in fact be negative at your delivery).
There are known products out there which women have used to ensure a negative GBS screen result. One such product is Hibi-Clens. This product is used to wash the genital area about 24 hours or less before the screening to kill the bacteria. This will kill the bacteria in the area washed. Under these circumstances, a negative result may mean the mother doesn’t carry group B strep OR it may mean that the group B was killed where she washed using the Hibi-clens. This does not guarantee that the bacteria isn't present in other locations.
If a mother chooses to not have antibiotics regardless of the test results, she can simply decline the test; however, declining the GBS screening during pregnancy may bring a wide array of provider-suggested invasive tests, or at least lengthy observation, of the newborn. If the parents opt to not be treated but wish to “appease” the providers AND avoid invasive, often painful, “just in case” tests, Hibi-clens could be a beneficial alternative.
If I have a positive GBS culture, what are my treatment options?
It is NOT recommended that colonized women (GBS +) take oral antibiotics before labor, as recent studies indicated that such course of treatment does not prevent GBS disease in newborns. There have not been a sufficient amount of studies to render a conclusion about the effectiveness of administration of intra-muscular antibiotics (those given by injections). According to the CDC, the recommended treatment, to reduce the risk of GBS infection in newborns of colonized women (it doesn't prevent it in all cases), is for the mothers to receive intrapartal (during labor) intravenous (I.V.) antibiotic treatment. At one time, physicians rendered any mother who had tested GBS + in the current pregnancy or any previous pregnancy to automatically be considered GBS positive and to not need the 37 week screening. However, due to the overuse of antibiotics, this policy has now been changed to apply to only mothers who have had a baby with GBS disease or have had urinary tract infections due to GBS. For women in labor, the antibiotic usually consists of at least two rounds of I.V. antibiotics. Usually these are penicillin type drugs.
Also, antibiotics are not 100% effective; a small percentage of babies may develop a Group B Strep infection—even with antibiotics. Though the antibiotic treatments have decreased the overall number of GBS disease in babies, the number of fatal infections has NOT decreased with antibiotic treatment.
What are the risks to having the GBS screening?
The heaviest risks stem from active treatment for those moms who test positive at the time, though in some women, just testing positive can lead to anxiety over health of their baby.
If the mom tests positive and if she opts to be treated........There have been some recent studies which have shown a correlation of the decline of GBS disease in newborns in response to the administration of antibiotics in labor, to a rise in E. Coli infections in newborns; E.Coli is a dangerous, sometimes deadly, bacteria which is just as serious, if not more so than GBS. In this study, moms who received antibiotics in labor were more likely to have their baby develop an infection from E. Coli which was also, unfortunately, resistant to antibiotic treatment. The theory in this study is that the overuse of antibiotics has caused the E.Coli bacteria to change itself to resist the antibiotics, rendering a "super bug" so to speak.
Thrush, which is a yeast infection of babies mouth spread to the mother’s breast, is also common at anytime a mother or baby is exposed to antibiotics. This can often cause major difficulties with breastfeeding and intense pain and itching in the mother.
The other downfall of being treated for GBS is the obvious: the mom will be required to have an IV which will greatly restrict her ability to move freely and will necessitate her arriving to the hospital in early labor. As with all things, do your research.....
Reproducible with full attribution; by Kristen Gibson